The Aging Neck
One of the tell tail signs of aging can the appearance of the neck. The neck is an important part of visible facial anatomy. When you are with another person, the interpretation of physical clues make false judgments. The “turkey gobbler” neck can be thought to be associated with laziness, gluttony, or debauchery. “Saggy neck skin” is often associated with advancing age and decreasing mental faculties. Aging necks vary widely. Some necks collect fat, some necks have hanging skin, while some necks have deep skin furrows or wrinkles.
The causes of an aging neck are multi-fold. Most of the appearance of the neck is due to genetics. Genetics play a huge role. In addition, sun damage and smoking cause radiation and free radical damage leading to premature thinning of the neck skin, loss of elastic fibers, and eventually, deep neck skin furrows or wrinkles. Poor eating habits can cause a large, thick neck. A long mandible or jaw line can also lead to increased hanging neck skin and fat.
There is a significant amount of research and development in the field of neck rejuvenation. Recently, significant medical and surgical advances have been made.
In the medical or minimally invasive treatment of the neck, neck injections hold significant promise. Previously known as ATX-101, Kybella was approved recently by the FDA for the treatment of the moderate to severe neck fat. Kybella is identical to a naturally occurring acid called deoxycholic acid. Deoxycholic acid is produced in our bodies and aides in fat absorption. When properly injected into the neck, Kybella destroys the fat cell membrane and thus, dissolves fat. Kybella has been shown to statistically reduce neck fat. Injection of Kybella is a relatively painless, in-office procedure. The office visit takes about 30 minutes. There is minimal downtime. There may be some mild bruising and mild swelling. The effects of Kybella may take several weeks to appear. There are many other fat burning injections on the near horizon being furverently researched.
In addition to Kybella lipolysis injections, fat can also be destroyed by heat or cold. Another recent addition to the “hot” armamentarium in the battle of the neck bulge has been radiofrequency. Radiofrequency delivers “hot” energy to the fat underlying the skin. Radiofrequency has the ability to not only melt neck fat, but by redirecting its energy, radiofrequency can also tighten neck skin. During the neck radiofrequency treatment, you may feel some warmth as your neck fat is heated and your neck skin is tightened. A neck radiofrequency treatment takes about 30 to 45 minutes. A neck radiofrequency treatment is performed in the office. Typically, three to four sessions are required to see results. Usually, these radiofrequency treatments are performed two weeks apart. There is no downtime except for some redness of the skin. The effects of radio frequency may take several weeks to appear.
Cold therapy or cryotherapy to eliminate fat is a relatively new concept. Recently, the FDA approved cryolipolysis for the removal of localized areas of fat. Cold therapy utilizes that fact that fat cells are more sensitive to cold than other surrounding skin cells. Cold therapy freezes the lipids of the fat cell. This lipid freezing causes the fat cell to dissolve. Neck cold therapy is an in-office procedure which takes about 30 minutes to perform. Neck cryotherapy may need to be repeated four to five times for effective results. There is no downtime. Results from neck therapy may take four to six months to appear.
In addition to Kybella neck injection and fat cell temperature modulation, neck fat cells can also be destroyed with ultrasound. Ultrasound uses high-intensity, focused, ultrasonic waves. These sound waves destroy targeted fat by passing safely through the skin. Neck ultrasound is an in-office procedure and takes about 30 to 45 minute to perform. Typically, neck ultrasound may need to be repeated four to five times for effective results. Results from neck ultrasound therapy may take four to six months to appear. Like radiotherapy and cold therapy, neck ultrasound has no downtime.
The surgical treatment of neck involves addressing two structures, namely neck fat and neck skin. The goal of surgical neck treatment is to rejuvenate the neck and to tighten the neck to obtain a chiseled, 90 degree neckline. Some necks need only fat removal. Some necks need only skin removal. Some necks need both skin and fat removal, while others need just skin tightening. To remove just neck fat, neck liposuction can be performed. Typically, a small (¼ inch) incision is placed in a skin crease under the chin. Sometimes equally small incisions are placed behind the earlobe. These strategic points allow full access to all areas of neck fat. Through these skin ports, a spatulated, neck liposuction cannulae (straw) is inserted and neck fat is removed directly. If loose neck skin is the issue, a suture can be placed in a crisscross fashion from the chin to the trachea. This suture provides a hammock-like support to the neck. Thus, the neck is pulled up toward the floor of the mouth and no neck skin is removed. However, if one has excess neck skin, this excess neck skin needs to be removed surgically. To remove excess neck skin, an incision needs to be made. There are a variety of stealth neck incisions which are used to reduce and tighten neck skin. The most common incision for neck skin removal is an incision which extends from the front of the ear, around the earlobe, and along the back of the ear. To secure the foundation of the neck, sometimes a neck muscle is tightened. This neck muscle is called the platysma. Through the chin incision, the platysma muscle is sewn together with permanent suture. The platysma is sewn together like a corset, so this portion of the procedure is called a “corset platsymaplasty”. In addition, sometimes to achieve a chiseled, 90 degree neck line, the platysma is partially or completely transected. During the neck platysmal procedures, further neck fat can be removed. After the muscle foundation of the neck has been established, the neck skin is pulled up and backward toward the ear and the excess skin is removed. The beauty of this incision is that the scar in concealed. This type of neck lift is often combined with a facelift. Another type of neck lift involves a direct zigzag incision on the front of the neck.
Most of the surgical treatments to the neck, can be performed under local, intravenous (IV), twilight, or general anesthesia. Procedures vary in length. Usually neck liposuction takes one hour, whereas a full neck lift with platsymaplasty may take two to three hours. During the recovery, a neck compression garment is worn for two weeks. Usually, results are seen right after surgery. However, your final neck results may take six to eight week to appear. Typically, five to seven days after a neck lift, patients can return to work.
By looking at your parents’ neck, glimpse into the future of your neck. Genetics have a powerful role in the appearance of the neck. Act early! Early intervention can minimize new and old social stigmata, improve your self esteem, and improve your business interactions. Get rid of that turkey gobbler and win the battle of the neck bulge!
This is a middle-aged female who was dissatisfied with her neck. On physical examination, she had excellent skin tone and moderate neck fat. She underwent a 30 minute, outpatient neck liposuction procedure. She achieved significant improvement in the contour of her neck with just neck liposuction alone. Please note her new, 90-degree, chiseled neck line. Individual results vary.
This is an older female who was dissatisfied with her neck. On physical examination, she had poor skin tone and significant neck fat. She did not want a surgical necklift or a facelift. She underwent several, in-office ultrasonic treatments. Then, she underwent a 60 minute, outpatient neck liposuction procedure. She achieved significant improvement in the contour of her neck with these modalities. Please note her new, youthful neck line. Individual results vary.
This is an older female who was dissatisfied with her neck. On physical examination, she had poor skin tone and moderate neck fat. To remove excess neck skin, lift the neck muscles, and rejuvenate the neck and face, she underwent a three hour necklift and facelift. After surgery, the patient was able to go home. She achieved significant improvement in the contour of her neck and face. Please note her new and improved neck line. Individual results vary.